Adverse childhood experiences and risk of suicide and substance-related mortality through middle adulthood.

Background: Few studies have prospectively examined whether adverse childhood experiences contribute to suicide or substance-related mortality. Moreover, children are often exposed to multiple adversities making it critical to identify which clusters of adversities are most harmful for these outcomes. Accordingly, we investigated risk for suicide and substance-related mortality based on the number and clusters of adversities children were exposed to.

Methods: Identifying information from 49,853 offspring born between 1959 and 1966 to participants in the Collaborative Perinatal Project was linked to the National Death Index to determine vital status by the end of 2016. We examined associations of the total number of adversities and five clusters of adversity (Low Adversity, Parental Harshness & Neglect, Family Instability, Poverty & Crowded Housing, Poverty & Parental Separation) with suicide and substance-related mortality.

Results: Of the 45,207 participants in the analysis sample, 267 died by suicide and 338 by substance use. Participants who experienced Family Instability had a higher risk of dying by suicide (hazard ratio [HR] = 1.92, 95%CI:1.32, 2.79) and substance use (HR = 1.50, 95%CI:1.02, 2.19). Participants who experienced Poverty & Parental Separation were at higher risk of dying by substance use (HR = 1.85, 95%CI:1.40, 2.45).

Limitations: Adversities with documented harm including physical and sexual abuse were not assessed in the study.

Conclusions: Childhood adversity is associated with self-injury mortality from multiple causes, suggesting shared etiology of risk for suicide and substance-related mortality. Research on interventions that target shared pathways linking childhood vulnerability to multiple causes of death may help reduce the long-term impact of adversities.